Gaps in HIV Care Exist After Incarceration

HIV-positive patients who are released from jail or prison may experience difficulties in accessing proper health care to treat the condition, according to a study published by The Lancet HIV.

The study authors hypothesized that these individuals may face significant barriers transitioning to life out of prison, which could impact if and when they meet with providers.

“In many ways, incarceration is destabilizing, because you’re taking people out of their communities rather than addressing the issues in the community,” said first author Kelsey Loeliger. “You’re giving them access to resources while they’re away, but it’s not really a sustainable solution, and it’s not really an ethical solution.”

The study looked specifically at HIV-positive patients being released from jails and prisons in Connecticut. After release, patients are given 14 days of antiretroviral therapy, but once that supply runs out, individuals are responsible for accessing their own treatment, according to the authors.

However, the researchers discovered that only 21% of these individuals visited a health care provider within 2 weeks of release. Another 33% did so within 1 month, according to the study.

The authors said that the health care services—including treatment—provided to patients during incarceration were beneficial to viral suppression, but they lost access to care once released from jail or prison.

For patients with HIV, it is critical to remain adherent to therapy to prevent adverse events and transmission.

The authors said patients may have a difficult time gaining access to health care after release due to multiple reasons, including homelessness, deteriorating health, and problems reintegrating into the community.

Additionally, the amount of time served in the institution was found to affect how long it takes patients to visit a provider.

HIV-positive individuals who were incarcerated between 30 days and 1 year received health care faster than those with a longer sentence, according to the study. The authors said that intermediate incarceration may not cut patients off from their communities, whereas serving a longer sentence may do so.

An approach that has shown promise is assigning case managers to address the needs of HIV-positive individuals, including making physician appointments, according to the study. However, the authors said that although patients can receive treatment and stop using drugs during incarceration, these issues persist after release.

“What you see from this paper is that the criminal justice system can be leveraged to improve outcomes, but it can’t be the sole source of medical care, which I think is the case for many of these individuals,” Loeliger said.